After completing this course, the reader will be able to:1. Use a modulation of chemotherapy according to modified geriatric assessment to improve outcomes for elderly patients with diffuse large B-cell lymphoma with an acceptable level of toxicity.2. Offer elderly patients the best tailored treatment while minimizing the dose-limiting toxicity.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTChemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under-or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged >70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclo-

(1) to evaluate the information needs of Italian elderly cancer patients (age > or =65 years), (2) to compare them with those of young patients (age 18-40 years). Between June 2004 and February 2005 we asked 122 elderly (mean age 72 years) and 52 young (mean age 33 years) cancer patients naïve for treatment to fill in two self-administered questionnaires exploring their needs for information and their psychological distress. The needs for information of elderly patients differed significantly from those of the young patients (p<0.0001); on contrast, both groups showed a similar psychological distress and the same reasons for seeking further information. Our results demonstrate that, more frequently than expected, Italian elderly cancer patients do not want complete information on their disease. Assessing to what extent elderly patients require information is essential for giving them tailored information.

The psychometric properties of the Italian version of PFS-r, as evaluated in cancer patients ongoing chemotherapy, were satisfactory. We suggest the possible implementation of the Italian PFS-r in the assessment of fatigue particularly when it has been more fully validated on a wider range of cancer patients.

Ageing is associated with an increased prevalence of chronic diseases, decreased functional reserve in multiple organ systems and enhanced susceptibility to stress. Ageing and the concomitant presence of a condition of frailty may predispose to the presence of fatigue. Nevertheless, only few studies have to date specifically assessed the impact of fatigue in the geriatric population. Since cancer-related fatigue is a peculiarly debilitating condition characteristic of elderly cancer patient population, we suggest the early recognition and thorough evaluation of the symptom fatigue, its co-existing causes (i.e. anaemia, mood disorders and sleep disturbances) and co-morbidities (i.e., endocrine disorders, metabolic, cardiovascular and liver diseases).

The information patients receive from the oncologist was rated the highest, as long as they were devoted enough time. Booklets and videotapes can partially overcome the lack of oral information given by medical doctors. A better informed patient does help the oncologist save time.